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Daniel J Livorsi, Margaret L Chorazy, Marin L Schweizer, Erin C Balkenende, Amy E Blevins, Rajeshwari Nair, Matthew H Samore, Richard E Nelson, Karim Khader, Eli N Perencevich
Background: Carbapenem-resistant Enterobacteriaceae (CRE) pose an urgent public health threat in the United States. An important step in planning and monitoring a national response to CRE is understanding its epidemiology and associated outcomes. We conducted a systematic literature review of studies that investigated incidence and outcomes of CRE infection in the US. Methods: We performed searches in MEDLINE via Ovid, CDSR, DARE, CENTRAL, NHS EED, Scopus, and Web of Science for articles published from 1/1/2000 to 2/1/2016 about the incidence and outcomes of CRE at US sites...
2018: Antimicrobial Resistance and Infection Control
Anil N Makam, Oanh Kieu Nguyen, Lei Xuan, Michael E Miller, James S Goodwin, Ethan A Halm
Importance: Despite providing an overlapping level of care, it is unknown why hospitalized older adults are transferred to long-term acute care hospitals (LTACs) vs less costly skilled nursing facilities (SNFs) for postacute care. Objective: To examine factors associated with variation in LTAC vs SNF transfer among hospitalized older adults. Design, Setting, and Participants: We conducted this retrospective observational cohort study of hospitalized older adults (≥65 years) transferred to an LTAC vs SNF during fiscal year 2012 using national 5% Medicare data...
March 1, 2018: JAMA Internal Medicine
Romney M Humphries, Janet A Hindler, Erin Epson, Sam Horwich-Scholefield, Loren G Miller, Job Mendez, Jeremias B Martinez, Jacob Sinkowitz, Darren Sinkowtiz, Christina Hershey, Patricia Marquez, Sandeep Bhaurla, Marcelo Moran, Lindsey Pandes, Dawn Terashita, James A McKinnell
Background: The Clinical and Laboratory Standards Institute (CLSI) revised the carbapenem breakpoints for Enterobacteriaceae in 2010. The number of hospitals that adopted revised breakpoints and the clinical impact of delayed adoption has not been explored. Methods: We performed a cross-sectional, voluntary survey of microbiology laboratories from California acute care hospitals and long-term acute care hospitals (LTAC) to determine use of revised CLSI breakpoints...
March 19, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Denis E Bergeron, Ryan Fitzgerald
The radionuclide copper-64 is a promising candidate for nuclear medicine, but its complex decay creates challenges in the primary standardization of its activity. Monte Carlo simulations of live-timed anticoincidence (LTAC) counting of 64 Cu were used to calculate corrections to extrapolation intercepts, resulting in improved activity determinations. A small correction (-0.33%) to the linear extrapolation of LTAC data acquired with a γ-gate over the 1346keV gamma peak was determined. We discuss the physical origin of the correction...
April 2018: Applied Radiation and Isotopes
Jorge F Velazco, Shekhar Ghamande, Salim Surani
Long-term acute care hospitals (LTACs) are health care facilities capable of admitting complex patients with high acuity that are unable to return home after hospitalization in acute care. Its defining characteristic is to accommodate patients for a length of stay greater than 25 days, however, little is known about its role of preventing hospital readmissions. Created in the 1980s, these facilities were designed to help acute care facilities improve their resource management, expenditures, and quality of care...
October 2017: Hospital Practice (Minneapolis)
F Shihab, Y Qazi, S Mulgaonkar, K McCague, D Patel, V R Peddi, D Shaffer
A key objective in the use of immunosuppression after kidney transplantation is to attain the optimal balance between efficacy and safety. In a phase 3b, multicenter, randomized, open-label, noninferiority study, the incidences of clinical events, renal dysfunction, and adverse events (AEs) were analyzed at 12 months in 309 de novo renal transplant recipients receiving everolimus (EVR), low-dose tacrolimus (LTac), and prednisone. Cox proportional hazard regression modeling was used to estimate the probability of clinical events at specified combinations of time-normalized EVR and Tac trough concentrations...
September 2017: American Journal of Transplantation
Miki Fujimori, Kazunori Kadota, Yuichi Tozuka
Transglycosylated stevia (stevia-G) can effectively improve the dissolution and bioavailability of poorly water-soluble drugs. Furthermore, addition of an ionic surfactant to stevia-G solution has been shown to enhance the dissolution effect of stevia-G on flurbiprofen. Herein, 4 surfactants, namely sodium dodecyl sulfate, sodium N-dodecanoylsarcosinate, sodium monododecyl phosphate, and lauryltrimethylammonium chloride (LTAC) were screened to investigate their synergistic effect with stevia-G in enhancing the solubility of mefenamic acid (MFA)...
April 2017: Journal of Pharmaceutical Sciences
Catherine VanGilder, Charlie Lachenbruch, Corrine Algrim-Boyle, Stephanie Meyer
PURPOSE: Measurement of pressure injury (PI) prevalence allows benchmarking within and across facilities; the International Pressure Ulcer PrevalenceTM (IPUP) Survey includes a variety of care settings. The purpose of this study is to present 10 years of US prevalence and limited demographic data (2006-2015) by care setting. METHODS: Facilities volunteer to participate in the IPUP Survey. Internal clinical teams collect data during a predetermined 24-hour period that includes pressure injury prevalence, demographics, and other pertinent clinical information...
January 2017: Journal of Wound, Ostomy, and Continence Nursing
Y Qazi, D Shaffer, B Kaplan, D Y Kim, F L Luan, V R Peddi, F Shihab, S Tomlanovich, S Yilmaz, K McCague, D Patel, S Mulgaonkar
In this 12-month, multicenter, randomized, open-label, noninferiority study, de novo renal transplant recipients (RTxRs) were randomized (1:1) to receive everolimus plus low-dose tacrolimus (EVR+LTac) or mycophenolate mofetil plus standard-dose Tac (MMF+STac) with induction therapy (basiliximab or rabbit anti-thymocyte globulin). Noninferiority of composite efficacy failure rate (treated biopsy-proven acute rejection [tBPAR]/graft loss/death/loss to follow-up) in EVR+LTac versus MMF+STac was missed by 1.4%, considering the noninferiority margin of 10% (24...
May 2017: American Journal of Transplantation
Christine Y Chang, Emmanuelle Fréchette, Faride Unda, Shawn D Mansfield, Ingo Ensminger
Rising global temperature and CO2 levels may sustain late-season net photosynthesis of evergreen conifers but could also impair the development of cold hardiness. Our study investigated how elevated temperature, and the combination of elevated temperature with elevated CO2, affected photosynthetic rates, leaf carbohydrates, freezing tolerance, and proteins involved in photosynthesis and cold hardening in Eastern white pine (Pinus strobus). We designed an experiment where control seedlings were acclimated to long photoperiod (day/night 14/10 h), warm temperature (22°C/15°C), and either ambient (400 μL L(-1)) or elevated (800 μmol mol(-1)) CO2, and then shifted seedlings to growth conditions with short photoperiod (8/16 h) and low temperature/ambient CO2 (LTAC), elevated temperature/ambient CO2 (ETAC), or elevated temperature/elevated CO2 (ETEC)...
October 2016: Plant Physiology
Anai N Kothari, Ryan M Yau, Robert H Blackwell, Colleen Schaidle-Blackburn, Talar Markossian, Matthew A C Zapf, Amy D Lu, Paul C Kuo
BACKGROUND: Discharge location is associated with short-term readmission rates after hospitalization for several medical and surgical diagnoses. We hypothesized that discharge location: home, home health, skilled nursing facility (SNF), long-term acute care (LTAC), or inpatient rehabilitation, independently predicted the risk of 30-day readmission and severity of first readmission after orthotopic liver transplantation. STUDY DESIGN: We performed a retrospective cohort review using Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases for Florida and California...
July 2016: Journal of the American College of Surgeons
Anil N Makam, Oanh K Nguyen, Jie Zhou, Kenneth J Ottenbacher, Ethan A Halm
OBJECTIVE: To assess regional trends in long-term acute care hospital (LTAC) use over time. DESIGN SETTING PARTICIPANTS: Retrospective study using 100% Texas Medicare data. Separate cohorts were created for each year from 2002-2011, which included all beneficiaries residing in 23 hospital referral regions (HRRs) with continuous enrollment in Parts A and B in the previous and current year, or until death. MEASUREMENTS: LTAC utilization rate was defined as the number of individuals with a LTAC stay per 100,000 Medicare beneficiaries residing in the HRR...
2015: Annals of Gerontology and Geriatric Research
Jeremy M Kahn, Amber E Barnato, Judith R Lave, Francis Pike, Lisa A Weissfeld, Tri Q Le, Derek C Angus
BACKGROUND: Long-term acute care hospitals (LTACs) provide specialized treatment for patients with chronic critical illness. Increasingly LTACs are co-located within traditional short-stay hospitals rather than operated as free-standing facilities, which may affect LTAC utilization patterns and outcomes. METHODS: We compared free-standing and co-located LTACs using 2005 data from the United States Centers for Medicare & Medicaid Services. We used bivariate analyses to examine patient characteristics and timing of LTAC transfer, and used propensity matching and multivariable regression to examine mortality, readmissions, and costs after transfer...
2015: PloS One
Renee Miller, Sarah Simmons, Charles Dale, Julie Stachowiak, Mark Stibich
Health care-associated transmission of Clostridium difficile has been well documented in long-term acute care facilities. This article reports on 2 interventions aimed at reducing the transmission risk: multidisciplinary care teams and no-touch pulsed-xenon disinfection. C difficile transmission rates were tracked over a 39-month period while these 2 interventions were implemented. After a baseline period of 1 year, multidisciplinary teams were implemented for an additional 1-year period with a focus on reducing C difficile infection...
December 1, 2015: American Journal of Infection Control
Manon R Haverkate, Martin C J Bootsma, Shayna Weiner, Donald Blom, Michael Y Lin, Karen Lolans, Nicholas M Moore, Rosie D Lyles, Robert A Weinstein, Marc J M Bonten, Mary K Hayden
OBJECTIVE: Prevalence of bla KPC-encoding Enterobacteriaceae (KPC) in Chicago long-term acute care hospitals (LTACHs) rose rapidly after the first recognition in 2007. We studied the epidemiology and transmission capacity of KPC in LTACHs and the effect of patient cohorting. METHODS: Data were available from 4 Chicago LTACHs from June 2012 to June 2013 during a period of bundled interventions. These consisted of screening for KPC rectal carriage, daily chlorhexidine bathing, medical staff education, and 3 cohort strategies: a pure cohort (all KPC-positive patients on 1 floor), single rooms for KPC-positive patients, and a mixed cohort (all KPC-positive patients on 1 floor, supplemented with KPC-negative patients)...
October 2015: Infection Control and Hospital Epidemiology
Pamela Ny, Paul Nieberg, Annie Wong-Beringer
BACKGROUND: Although high mortality associated with carbapenem-resistant Klebsiella pneumoniae (CRKP) bacteremia has been well described, the epidemiology and outcomes of nonbacteremic infection are unknown. METHODS: Medical charts of adults hospitalized for CRKP pneumonia or urinary tract infection between January 2011 and December 2013 were reviewed retrospectively for relevant demographic and clinical details. Cases were matched to controls (non-carbapenem-resistant, non-extended-spectrum beta-lactamase [ESBL]-producing K pneumoniae [NRKP]) by the primary site of infection and year of isolation and compared in terms of risk of acquisition and outcomes...
October 1, 2015: American Journal of Infection Control
Lane Koenig, Berna Demiralp, Josh Saavoss, Qian Zhang
BACKGROUND: Little evidence exists on the effects of receiving care in a long-term acute care hospital (LTCH). OBJECTIVE: To examine LTCH effects on mortality and Medicare payments overall and among high-acuity patients. RESEARCH DESIGN: A retrospective cohort study of Medicare beneficiaries using probit and generalized linear models. An instrumental variable technique was used to adjust for selection bias. SUBJECTS: Medicare beneficiaries within 5 major diagnostic categories and not on prolonged mechanical ventilation...
July 2015: Medical Care
N Sasanuma, K Takahashi, Y Itani, T Tanaka, S Yamauchi, S Mabuchi, N Kodama, M Ishihara, T Masuyama, Y Miyamoto, K Domen
BACKGROUND: Although numerous studies on Functional Independence Measure (FIM) analysis in stroke, orthopedic disease, and spinal cord injury patients have been conducted, it has rarely been done in patients undergoing cardiac rehabilitation (CR). AIM: To verify whether the Functional Independence Measure (FIM) score, and its subscale motor FIM and cognitive FIM, during inpatient CR can be a predictor of a patient's readiness for home discharge by establishing an FIM cutoff value...
December 2015: European Journal of Physical and Rehabilitation Medicine
Cecile Davis, Miriam Bender, Tyler Smith, Jason Broad
BACKGROUND: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) are chronic diseases that impart significant health and care costs to the patient and health system. Limited access to health services affects disease severity and functional status. Telemonitoring has shown promise in reducing acute care utilization for chronic disease patients, but the benefit for the underserved has not been determined. We evaluated acute care utilization outcomes following an acute event of a 90-day transitional care program integrating telemonitoring technology and home visits for underserved COPD and HF patients...
September 2015: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
Teena Chopra, Ellie J C Goldstein
Across the United States, the baby boomers are entering into their elderly years. As they are America's largest generation to do so to date, their need for care will greatly affect nursing homes, long-term care facilities, and long-term acute-care hospitals (LTACHs). Unfortunately, the rise of Clostridium difficile infection (CDI), particularly in extended-care facilities, might become the biggest obstacle in their care. Elderly extended-care-facility residents are at an elevated risk of CDI simply due to their advanced age and the fact that they are receiving care in an extended-care facility...
May 15, 2015: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
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